Aortic Valve Replacement: Treatment by Sternotomy versus Minimally Invasive
            Approach

Ferreira, Renata Tosoni Rodrigues; Silva, Roberto Rocha E; Marchi, Evaldo

doi:10.5935/1678-9741.20160085

Cited by 8 publications

(12 citation statements)

References 27 publications

(92 reference statements)

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“…Recently, the number of cases with aortic pathology has increased markedly, which has resulted in the search for conservative surgical treatment methods [ 1 , 2 , 3 ]. Consequently, new minimally invasive approaches (e.g., upper and lower ministernotomy; V-shaped, Z-shaped, T-shaped, J-shaped sternotomy; and other types of ministernotomy) have been introduced [ 4 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

et al. 2018

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Background: new minimally invasive sternotomy (mini-sternotomy) procedures have improved the treatment outcome and reduced the incidence of perioperative complications leading to improved patient satisfaction and a reduced cost of aortic valve replacement in comparison to the conventional median sternotomy (full sternotomy). The aim of this study is to compare and gain new insights into operative and early postoperative outcomes, long-term postoperative results, and 5-year survival rates after aortic valve replacement through a ministernotomy and full sternotomy. Methods: This is a retrospective study of patients who underwent an isolated replacement of the aortic valve via a full sternotomy or ministernotomy from 2011 to 2016. From 2011 to 2016, 426 cardiac interventions were performed, 70 of which (16.4%) were of the ministernotomy and 356 (83.6%) of the full sternotomy. Through propensity score matching, 70 patients who underwent the ministernotomy (ministernotomy group) were compared with 70 patients who underwent the full sternotomy (control group). Results: in the propensity matching cohort, no statistical difference in operative time was noted (p = 0.856). The ministernotomy had longer cross clamp (88.7 ± 20.7 vs. 80.3 ± 24.6 min, p = 0.007) and bypass (144.0 ± 29.9 vs. 132.9 ± 44.9 min, p = 0.049) times, less ventilation time (9.7 ± 1.7 vs. 11.7 ± 1.4 h, p < 0.001), shorter hospital stay (18.3 ± 1.9 vs. 21.9 ± 1.9 days, p = 0.012), less 24-h chest tube drainage (256.2 ± 28.6 vs. 407.3 ± 40.37 mL, p < 0.001), fewer corrections of coagulopathy (p < 0.001), fewer patients receiving catecholamine (5.71 vs. 30.0%, p < 0.001) and better cosmetic results (p < 0.001). Moreover, the number of patients without complaints at 1 year after the operation was significantly greater in the ministernotomy group (p = 0.002), and no significant differences in the 5-year survival between the groups were observed. In the overall cohort, the ministernotomy had longer cross clamp times (88.7 ± 20.7 vs. 79.9 ± 24.8 min, p < 0.001), longer operative times (263.5 ± 62.0 vs. 246.7 ± 74.2 min, p = 0.037) and bypass times (144.0 ± 29.9 vs. 132.7 ± 44.5 min, p = 0.026), lower incidence of 30-day mortality (1(1.4) vs. 13(3.7), p = 0.022), shorter hospital stays post-surgery p = 0.025, less 24-h chest tube drainage, p < 0.001, and fewer corrections of coagulopathy (p < 0.001). Conclusions: the ministernotomy has a number of advantages compared with the full sternotomy and thus could be a better approach for aortic valve replacement.

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Section: Introductionmentioning

confidence: 99%

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

et al. 2018

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“…The rst was that the study was observational, and patients were not randomized, so there were some age and weight differences between the MS and MT groups that could in uence the results. However, previous studies have not shown any difference in age and weight between MS and conventional full sternotomy for AVR [20][21][22]. The second limitation was that our study was under powered and was not su cient to de nitively reject the hypothesis that there was no correlation between MES count and development of delirium and cognitive decline.…”

Section: Limitationsmentioning

confidence: 78%

“…However, some authors have suggested that smaller incisions led to poor surgical led exposure, potentially making the surgery technically more demanding and with longer operative times [22].…”

Section: Discussionmentioning

confidence: 99%

Cerebral Microemboli in Mini-Sternotomy Compared to Mini-Thoracotomy for Aortic Valve Replacement: A Cross Sectional Cohort Study

Bozhinovska

Jenko

Stupica

et al. 2020

Preprint

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Background: Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation.Methods: Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure.Results: A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8±14.4 vs.72±5.84, p=0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p= 0.002) and had higher body surface area (1.98 ±0.167 vs. 1.83±0.178, p=0.006).Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ±24 vs. 134±30 min, p<0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p=0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p=0.630) (MS: 85.2±9.6 vs. 82.9±11.4, p=0.012; MT: 85.2±9.6 vs. 81.3±8.8, p=0.001). Conclusion: There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline.

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“…However, some authors have suggested that smaller incisions led to poor surgical filed exposure, potentially making the surgery technically more demanding and with longer operative times [ 27 ].…”

Section: Discussionmentioning

confidence: 99%

Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study

Bozhinovska

Jenko

Stupica

et al. 2021

J Cardiothorac Surg

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Background Recently adopted mini-thoracotomy approach for surgical aortic valve replacement has shown benefits such as reduced pain and shorter recovery, compared to more conventional mini-sternotomy access. However, whether limited exposure of the heart and ascending aorta resulting from an incision in the second intercostal space may lead to increased intraoperative cerebral embolization and more prominent postoperative neurologic decline, remains inconclusive. The aim of our study was to assess potential neurological complications after two different minimal invasive surgical techniques for aortic valve replacement by measuring cerebral microembolic signal during surgery and by follow-up cognitive evaluation. Methods Trans-cranial Doppler was used for microembolic signal detection during aortic valve replacement performed via mini-sternotomy and mini-thoracotomy. Patients were evaluated using Addenbrooke’s Cognitive Examination Revised Test before and 30 days after surgical procedure. Results A total of 60 patients were recruited in the study. In 52 patients, transcranial Doppler was feasible. Of those, 25 underwent mini-sternotomy and 27 had mini-thoracotomy. There were no differences between groups with respect to sex, NYHA class distribution, Euroscore II or aortic valve area. Patients in mini-sternotomy group were younger (60.8 ± 14.4 vs.72 ± 5.84, p = 0.003), heavier (85.2 ± 12.4 vs.72.5 ± 12.9, p = 0.002) and had higher body surface area (1.98 ± 0.167 vs. 1.83 ± 0.178, p = 0.006). Surgery duration was longer in mini-sternotomy group compared to mini-thoracotomy (158 ± 24 vs. 134 ± 30 min, p < 0.001, respectively). There were no differences between groups in microembolic load, length of ICU or total hospital stay. Total microembolic signals count was correlated with cardiopulmonary bypass duration (5.64, 95%CI 0.677–10.60, p = 0.027). Addenbrooke’s Cognitive Examination Revised Test score decreased equivalently in both groups (p = 0.630) (MS: 85.2 ± 9.6 vs. 82.9 ± 11.4, p = 0.012; MT: 85.2 ± 9.6 vs. 81.3 ± 8.8, p = 0.001). Conclusion There is no difference in microembolic load between the groups. Total intraoperative microembolic signals count was associated with cardiopulmonary bypass duration. Age, but not micorembolic signals load, was associated with postoperative neurologic decline. Trial registry number clinicaltrials.gov, NCT02697786 14.

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Aortic Valve Replacement: Treatment by Sternotomy versus Minimally Invasive Approach

Cited by 8 publications

References 27 publications

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

Efficacy of Aortic Valve Replacement through Full Sternotomy and Minimal Invasion (Ministernotomy)

Cerebral Microemboli in Mini-Sternotomy Compared to Mini-Thoracotomy for Aortic Valve Replacement: A Cross Sectional Cohort Study

Cerebral microemboli in mini-sternotomy compared to mini- thoracotomy for aortic valve replacement: a cross sectional cohort study

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